精神发育迟滞合并精神分裂症的临床研究

目的探讨精神发育迟滞（MR）合并精神分裂症的临床特点。方法 48例MR合并精神分裂症患者按智商（IQ）≥50和IQ≤49分为两组进行临床特征分析,并与48例智力正常的精神分裂症患者比较。结果 MR合并精神分裂症患者IQ≥50和IQ≤49两组间临床差异无显著性（P≥0.05）;MR合并精神分裂症组与正常智力精神分裂症组的一级症状[1]、逻辑推理障碍、妄想、情感平淡、思维贫乏的差异有显著性（P〈0.01或P〈0.05）。结论 MR合并精神分裂症一级症状明显减少,有助于临床鉴别。     

精神发育迟滞并发精神分裂症与精神分裂症症状特点比较

目的 探讨精神发育迟滞(MR)并发精神分裂症与精神分裂症症状特点比较。方法 100例MR并发精神分裂症患者按智商(IQ)≥50和IQ≤49分成两组进行临床特征分析,并与100例智力正常的精神分裂症患者比较。结果 MR并发精神分裂症患者IQ≥50和IQ≤49两组间临床症状差异无显著性(P>0.05);MR并发精神分裂症组与正常智力的精神分裂症组的一级症状、逻辑推理障碍、妄想、情感平淡、思维贫乏、愚蠢行为的差异有非常显著性(P<0.01)。结论 MR并发精神分裂症患者一级症状明显减少,有助于鉴别诊断。     

氯氮平合并丙咪嗪治疗衰退期精神分裂症阴性症状的对照研究

目的　评价氯氮平合并丙咪嗪对衰退期精神分裂症阴性症状的治疗效果。方法　将 38例以阴性症状为主的衰退期精神分裂症患者随机分成两组 ,进行为期 12周的对照研究。分别用氯氮平合并丙咪嗪(治疗组 )和氯氮平 (对照组 )治疗。采用BPRS、SANS和TESS评定标准进行评定。结果　无论治疗组还是对照组治疗前后SANS评分差异无显著性 (P >0 .0 5 )。两组治疗前后SANS评分差异无显著性 (P >0 .0 5 )。结论　氯氮平合并丙咪嗪对衰退期精神分裂症阴性症状的疗效与单用氯氮平疗效相仿 ,丙咪嗪对改善阴性症状无效     

丁螺环酮、阿立哌唑合并利培酮治疗精神分裂症患者的疗效分析

目的研究丁螺环酮、阿立哌唑合并利培酮治疗精神分裂症患者的疗效及对患者阴性症状及认知功能的影响。方法以随机数字表法将我院收治的152例精神分裂症患者分为对照组(76例)和观察组(76例)。对照组患者采用阿立哌唑合并利培酮治疗,观察组患者采用丁螺环酮合并利培酮治疗。两组患者连续治疗3个月后,比较两组患者临床疗效、阴性症状、认知功能以及不良反应发生情况。结果观察组患者临床疗效总有效率显著高于对照组,差异有统计学意义(P0.05)。两组患者治疗前阴性症状量表(SANS)评分、认知能力筛查实验量表(CASI)评分比较差异无统计学意义(P0.05);两组患者治疗后SANS评分、CASI评分均有显著改善(P0.05);且治疗后观察组SANS评分显著低于对照组,差异有统计学意义(P﹤0.05);治疗后观察组CASI评分显著高于对照组,差异有统计学意义(P0.05)。观察组患者总不良反应发生率显著低于对照组,差异有统计学意义(P0.05)。结论丁螺环酮合并利培酮治疗精神分裂症具有良好临床疗效,可有效改善患者阴性症状、认知功能,且安全性较高。     

精神分裂症的阴性症状与抑郁症的症状比较

目的　比较精神分裂症的阴性症状和抑郁症的症状差异。方法　用SANS和HAMD量表评定 4 8例精神分裂症的阴性症状和 4 5例抑郁症的症状 ,评定结果进行统计学处理。结果　SANS总分两组无显著性差异 (P >0 0 5 ) ;思维贫乏分量表分精神分裂症组明显高于抑郁症组 (P <0 0 1)。HAMD总分抑郁症组明显高于精神分裂症组 (P <0 0 1) ,其中尤以抑郁情绪、罪恶感、自杀、早醒和体重减轻突出。结论　精神分裂症的阴性症状与抑郁症的症状之间存在明显的差异 ,而且是鉴别诊断的要点之一     

奥氮平与氯氮平治疗精神分裂症对照研究

目的　研究奥氮平治疗精神分裂症的疗效及安全性。方法　分析 6 1例用奥氮平治疗 6周的精神分裂症病例 ,并与 6 1例用氯氮平治疗的精神分裂症病例作对照 ,采用阳性及阴性症状量表 (PANSS)的减分率评价疗效 ,用副作用量表 (TESS)评价 6周末的副作用。结果　 6周末PANSS量表总分、阳性症状分、阴性症状分和一般病理分与治疗前比较 ,两组差异均有非常显著性 (P <0 .0 1) ,但两组间差异无显著性 (P >0 .0 5 )。于 2周末两组间除一般病理分外 ,余差异均有极显著性 (P <0 .0 1) ;于第四周末一般病理分差异也有非常显著性 (P <0 .0 1) ;副作用两组间比较 ,奥氮平组明显小于氯氮平组。结论　奥氮平治疗精神分裂症疗效好、起效快、副作用小。     

舍曲林合并舒必利治疗精神分裂症的临床研究

目的探讨舍曲林合并舒必利治疗精神分裂症的疗效和安全性。方法将86例符合CCMD-3诊断标准的精神分裂症患者随机分为研究组与对照组,研究组给予舍曲林合并舒必利治疗,对照组服用利培酮,疗程8周,用PANSS、CGI、BPRS及TESS评定疗效和安全性。结果疗后8周舍曲林合并舒必利组总有效率为88．37%,维思通组总有效率69．77%,两组比较有显著性差异(P＜0．05)。两组治疗前后PANSS、BPRS评分均有明显下降(P＜0．05),两组间比较研究组两量表总分下降更明显,差异有显著性(P＜0．05),尤其PANSS中一般精神病理量表分、BPRS中缺乏活力因子分、焦虑抑郁因子分差异显著(P＜0．05)。结论舍曲林合并舒必利治疗精神分裂症阴性与阳性症状疗效可靠,不良反应小,大大提高患者的生活质量。     

首发精神分裂症患者的糖代谢研究

目的　探讨首发精神分裂症患者的糖代谢情况。方法　对 86例首发精神分裂症患者及 45名健康人进行糖耐量试验(OGTT) ,并检测其空腹血浆胰岛素、C肽的浓度。结果　两组间空腹血糖、餐后 3h血糖、空腹胰岛素、C肽的差异无显著性 ,病例组餐后 1h血糖值 [( 7 89± 1 77)mmol/L]、2h的血糖值 [( 6 2 4± 1 14 )mmol/L]、OGTT血糖曲线下面积 (AUC) [( 18 2 4± 2 76)mmol/(L·h) ]比对照组 [分别为 ( 6 5 4± 1 84)mmol/L ,( 5 88± 2 78)mmol/L ,( 15 86± 1 93 )mmol/L/h ,P分别小于 0 .0 1、0 .0 5、0 0 1]要大 ;组间糖耐量减退 (IGT)的发生率无显著性差异 ( χ2 =0 5 84,P >0 0 5 ) ;偏执型患者组与青春型患者组间的空腹血糖、2h血糖值无显著性差异 (t=1 476,P均大于 0 0 5 ) ;发生IGT的病例组与未发生IGT病例组组间阳性和阴性症状量表 (PANSS)总分及 4个分量表分值的差异无显著性差异 (P均大于 0 0 5 )。结论　首发精神分裂症患者存在餐后高血糖现象。     

儿童精神分裂症强迫症状的临床特征研究

目的　了解儿童精神分裂症强迫症状的临床特征。方法　采用自编的调查表 ,对 110例住院精神分裂症患者 (年龄≤ 15岁 )的病案资料进行分析。根据有无强迫症状 ,分为两组 ,即研究组 (有强迫症状 )和对照组 (无强迫症状 )。结果　 (1)强迫症状的发生率为 2 2 .73% (2 5 / 110 ) ;(2 )强迫观念主要见于 13～ 15岁儿童 ,强迫动作主要见于 8～ 12岁儿童 ;(3)研究组和对照组在住院天数、住院次数以及疗效方面差异均有显著性 (P <0 .0 1或P <0 .0 5 )。结论　强迫症状可能出现于儿童精神分裂症的各个时期 ,表明它是精神分裂症的一个组成部分 ,并且与精神分裂症的预后有关     

奎硫平与利培酮治疗首发精神分裂症的对照研究

目的 :比较奎硫平和利培酮治疗首发精神分裂症的临床疗效与安全性。方法 :对 6 0例首发住院的女性精神分裂症患者 ,随机分为两组 ,分别用奎硫平和利培酮进行 8周治疗。采用阳性症状与阴性症状量表 (PANSS)评定疗效 ,用副反应量表 (TESS)评定不良反应。　结果 :2种药物对首发精神分裂症的疗效相当。两组患者在嗜睡 ,锥体外系症状及月经功能紊乱方面的不良反应差异有显著性 (P <0 .0 5 )。　结论 :奎硫平、利培酮对精神分裂症疗效相似 ,不良反应均较轻。     

Epilepsy and anomalies of neuronal migration: MRI and clinical aspects

Neuronal migration disorders are the result of disturbed brain development. In such disorders, neurons are abnormally located. In diagnosing these conditions, magnetic resonance imaging is superior to any other imaging technique. This enables us to improve our knowledge of the clinical correlates of neuronal migration. With reference to migrational disorder, a retrospective study of all 303 patients with epileptic seizures referred for magnetic resonance imaging during a 3-year period was performed, 13 patients (aged 12-41, mean age 27) were identified. They represent 4.3% of the entire study group. Of the patients with known epilepsy, 6.7% and of the mentally retarded, 13.7% had migrational disorders. Four patients had schizencephaly as the dominant finding, one was classified as hemimegalencephaly, 2 had isolated heterotopias, and 6 had localized pachy- and/or poly-microgyria. The clinical pictures are complex. Ectopias of grey matter are recognised foci of epilepsy, but from an epileptological and a clinical viewpoint little attention has been given to these disorders. The present study shows that malmigration is not rare in epilepsy patients, especially not in the mentally retarded.     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.     

Hepatic Considerations in the Use of Antiepileptic Drugs

Summary: Virtually all of the major antiepileptic drugs (AEDs) can cause hepatotoxicity, although fatal hepatic reactions are rare. The mechanisms, incidences, and risk profiles for such reactions differ from drug to drug. With carbamazepine and phenytoin, hepatotoxicity may be due to drug hypersensitivity. Although the profiles of patients at risk have not been well-defined for these two antiepileptic drugs, it would appear from reports in the literature that older adolescents and adults are at higher risk than children of developing serious or fatal hepatotoxicity. Once hepatotoxicity develops, mortality rates are 10–38% with phenytoin and 25% for carbamazepine. The risk profile for valproate fatal hepatotoxicity has been more clearly defined. Those at primary risk of fatal hepatic dysfunction are children under the age of 2 years who are receiving multiple anticonvulsants and also have significant medical problems in addition to severe epilepsy. The risk is considerably lower for patients over the age of 2 years on valproate monotherapy. In contrast to the risk profile with other AEDs, adults receiving valproate as monotherapy have the lowest risk of hepatotoxicity. Fatal hepatic dysfunction coincident with valproate may be the result of aberrant drug metabolism. Concomitant use of AEDs that induce microsomal P450 enzymes (e.g., phenytoin and phenobarbital) may enhance the production of a toxic metabolite, and hence the greater risk of hepatotoxicity with polypharmacy.     

Vascular Malformations and Epilepsy: Clinical Considerations and Basic Mechanisms

Summary: Vascular malformations (VMs) are associated with epilepsy. The natural history of the various VMs, clinical presentation, and tendency to provoke epilepsy determine treatment strategies. Investigations have probed the mechanisms of epileptogenesis associated with these lesions. Electrophysiologic changes are associated with epileptogenic cortex adjacent to VMs. Putative pathophysiologic mechanisms of epileptogenesis include neuronal cell loss, glial proliferation and abnormal glial physiology, altered neurotransmitter levels, free radical formation, and aberrant second messenger physiology.     

Neonatal Seizures: Problems in Diagnosis and Classification

Summary: The clinical identification of neonatal seizures is critical for the recognition of brain dysfunction; however, diagnosis is often difficult because of the poorly organized and varied nature of these behaviors. Current classification systems are limited in their ability to communicate motor, autonomic, and electroencephalo-graphic features of seizures precisely and to provide a basis for uniform effective diagnosis, therapy, and determination of prognosis. Recent investigations of neonates, utilizing bedside electroencephalographic/polygraphic/ video monitoring techniques, have provided the basis for improved diagnosis and classification of seizures in the newborn. These studies have demonstrated that not all clinical phenomena currently considered to be seizures require electrocortical epileptiform activity for their initiation or elaboration. In addition, the specific clinical character of the phenomena considered to be seizures, the clinical state of the infant, and the character of the EEG indicate the probable pathophysiological mechanisms involved and suggest probable etiologies, prognosis, and therapy. Similarities between animal models that demonstrate reflex physiology and neonates with motor automatisms and tonic posturing suggest that these clinical behaviors may not be epileptic in origin but, rather, primitive movements of progression and posture mediated by brainstem mechanisms. Although not all clinical behaviors currently considered to be neonatal seizures may have similar pathophysiological mechanisms, they are clinically significant because they all indicate brain dysfunction.     

Valproate Monotherapy in the Management of Generalized and Partial Seizures

Summary: For decades, therapeutic tradition has promoted the concept of polypharmacy in the management of epilepsy. In recent years, however, studies have shown that, for most patients, monotherapy can provide comparable or better seizure control than administration of multiple anticonvulsants, while diminishing the potential for adverse reactions, drug interactions, and poor compliance. Valproate is an important monotherapeutic agent that is highly effective in the control of idiopathic primary and secondarily generalized epilepsies, and partial seizures that do not generalize. Comparative studies have found that valproate is at least as effective as phenytoin and carbamazepine in the treatment of generalized and partial seizures. Given the similar efficacy, other factors such as pharmacokinetics and side effects may therefore determine anticonvulsant selection for monotherapy.     

Un nouveau cadre conceptuel de travail pour la psychiatrie

In an attempt to place psychiatric thinking and the training of future psychiatrists more centrally into the context of modern biology, the author outlines the beginnings of a new intellectual framework for psychiatry that derives from current biological thinking about the relationship of mind to brain. The purpose of this framework is twofold. First, it is designed to emphasize that the professional requirements for future psychiatrists will demand a greater knowledge of the structure and functioning of the brain than is currently available in most training programs. Second, it is designed to illustrate that the unique domain which psychiatry occupies within academic medicine, the analysis of the interaction between social and biological determinants of behavior, can best be studied by also having a full understanding of the biological components of behavior.     

Carbamazepine Efficacy and Utilization in Children

Summary: Carbamazepine is effective for preventing partial and generalized tonic-clonic seizures in children. Although absence epilepsies are more common in children than adults, an estimated 80% of children with epilepsy have seizure types or epilepsies that are potentially responsive to carbamazepine. The differential diagnosis of ictal staring is an especially important issue in children because absence and atypical absence seizures are more prevalent in children than adults. Age-related pharmacokinetic differences and drug interactions are major considerations in children. On average, children have higher clearance rates of carbamazepine, shorter half-lives, and higher ratios of carbamazepine-10, 11-epoxide to carbamazepine than adults. In addition, children with severe epilepsy are more likely to require multiple-drug therapy, which can lead to complex drug interactions. When carbamazepine is administered along with valproate, drug protein binding interactions can cause intermittent side effects.